AANA Lab Course 908-Foot and Ankle Arthroscopy (APEx)-Options for Arthroscopic Repair_ Is the Verdict In

Options for Arthroscopic Repair_ Is the Verdict In_-Peter Mangone, M.D

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The presentation by Dr. Peter G. Mangone at AANA June 2019 addresses the evolving role of arthroscopic lateral ligament reconstruction for ankle instability, particularly the Arthroscopic Brostrom procedure. Traditional lateral ankle ligament repairs—primarily open anatomic procedures like the Brostrom and modified Brostrom techniques—have been the gold standard. However, they come with a 5-10% rate of patient dissatisfaction or recurrent instability, often linked to residual pain or undiagnosed intra-articular pathology.<br /><br />Arthroscopy allows direct visualization to detect and treat associated joint lesions, providing less postoperative pain, swelling, and faster rehabilitation in parallels with knee and shoulder ligament repairs. Although early arthroscopic approaches had poor outcomes, improvements in technique and instrumentation have enabled results equivalent or superior to open surgery. Worldwide, multiple surgeons independently developed arthroscopic Brostrom techniques.<br /><br />Since 2014, at least 28 studies, including 10 with over 12 months follow-up, report comparable or better clinical outcomes with arthroscopic repairs, often allowing earlier partial weight-bearing with brace use rather than prolonged casting. Recurrence rates are generally lower (around 1.5% in Dr. Mangone’s series of 400 cases) with high patient satisfaction, less swelling, better cosmesis, and faster return to function.<br /><br />The 2-anchor arthroscopic Brostrom technique is biomechanically equivalent to open repairs. Careful attention to surgical landmarks and passing sutures to include the inferior extensor retinaculum enhance stability and control subtalar instability. Postoperative protocols promote early protected weight-bearing and rehabilitation, with return to sports at about 3-4 months.<br /><br />Augmentation with Internal Brace has shown promise in enabling earlier return to sport, although strong clinical evidence beyond 6 months is limited. New minimally invasive techniques like the Anti-ROLL are emerging but lack definitive outcome data.<br /><br />In summary, fully arthroscopic lateral ligament reconstruction is safe, effective, reproducible, and results in earlier rehabilitation. The “verdict” is positive: arthroscopic Brostrom procedures work, offering a modern standard for managing chronic lateral ankle instability.

Keywords

arthroscopic lateral ligament reconstruction

ankle instability

Arthroscopic Brostrom procedure

open anatomic Brostrom repair

intra-articular pathology

postoperative rehabilitation

2-anchor arthroscopic Brostrom technique

inferior extensor retinaculum

Internal Brace augmentation

Anti-ROLL technique